National Hell Insurance vs sustainable national health

The road to hell is paved with good intentions. National Hell Insurance (NHI) is born of a noble motive – redress for historic inequalities.

NHI derives from the National Development Plan endorsed by political parties in 2011. And it gives meaning to the SA Constitution, which says in section 27, “(1) Everyone has the right to have access to healthcare services”.

Despite this pedigree, the NHI Bill has sparked outrage, reminiscent of TS Eliot’s observation, “Between the idea, And the reality …. Falls the Shadow”.

The shadow of doubt stalks the NHI, which is blamed for an increase in the exodus of medical professionals and a decrease in Discovery’s share price. Ironically, Discovery’s founder Adrian Gore is optimistic. He believes SA is much better off now than during apartheid.

Gore is an actuary. Interestingly, the most consistent criticism of the NHI is that it has not been costed. For example, economist Thabi Leoka tweeted: “Were there any actuaries consulted at any stage of the #NHI idea?”

This question has not been answered by health officials, who say Treasury must sort out the funding. The retort that SA cannot afford not to implement NHI is both glib and threatening. There’s an unsubtle warning of violent upheaval if the masses don’t receive better treatment and medication cheaply, soon. So pay up.

Curiously, the NHI Bill includes phrases such as “sustainable and affordable universal access to quality healthcare services”, yet there is no evidence that the drafters have any understanding of what sustainability and affordability entail. Sustainability must have an economic component.

So after eight years of deliberations, there is no clarity on how much NHI will cost, nor detail on how the money will be raised, except that middle and upper classes will pay more, and their range of choices will shrink. The figurative geese that lay golden eggs are fearful of being plucked and tethered.

Their migration will further impoverish the shrinking fiscus. Those who can afford to emigrate are doing so in droves. They include doctors and nurses whose training has been subsidised by taxpayers. Profmed says the number of its health professional members leaving rose from 17% to 30% in June and July.

Decisions to leave the country are understandable in a negative climate. If every stateowned entity is riddled with corruption and incompetence, how can we trust an untested health plan whose budget will dwarf Eskom’s?

Nor can we have faith in cadres who allowed the deadly horrors of Life Esidimeni, and pensioners chained to beds, plus the endless queues and frustrations that bedevil state hospitals.

Nothing has been learned from pointless NHI pilot projects costing R4 billion.

Yet emigration is a cop-out if it means giving up on the dream of a prosperous, united SA. Compromise is needed between those who are shouting past each other without listening.

Sustainable national health requires more give and take between socialist control-freak pipe-dreamers and those inclined to flee the coming nightmare.

Rather than get the hell out of here, let’s take the “hell” out of NHI.

Martin Williams, DA councillor and former editor of The Citizen.

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